anesthesia question, ASA nerve block

[Dentrix and Drill]

Hey all, first year dental student here. Need advice on ASANB

We are learning anesthesia injection techniques right now, really cool stuff. One injection, the anterior superior alveolar nerve block (infraorbital) has me a bit worried! I've seen extractions done on 6-11 on one patient in a single visit, so I think bilateral ASA would be a viable injection for that procedure.

In our notes, it says to use a long needle, parallel to the maxilary bone, and proceed up to the infraorbital foramen until you contact the bone on the roof of the infraorbital foramen!!! Last semester we had gross anatomy, and lemme tell ya, finding that foramen without destroying overlying structures was a PAIN. I think it will be even harder with a syringe. The needle we use is a long needle about 32mm and we go in from the height of mucobuccal fold above Mx1P.. We only go in about 16mm. I'm worried about possibly damaging the eye if the patient freaks out, and not being able to find the foramen with the needle.

Any advice?

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[sgv]

Hey all, first year dental student here. Need advice on ASANB

We are learning anesthesia injection techniques right now, really cool stuff. One injection, the anterior superior alveolar nerve block (infraorbital) has me a bit worried! I've seen extractions done on 6-11 on one patient in a single visit, so I think bilateral ASA would be a viable injection for that procedure.

In our notes, it says to use a long needle, parallel to the maxilary bone, and proceed up to the infraorbital foramen until you contact the bone on the roof of the infraorbital foramen!!! Last semester we had gross anatomy, and lemme tell ya, finding that foramen without destroying overlying structures was a PAIN. I think it will be even harder with a syringe. The needle we use is a long needle about 32mm and we go in from the height of mucobuccal fold above Mx1P.. We only go in about 16mm. I'm worried about possibly damaging the eye if the patient freaks out, and not being able to find the foramen with the needle.

Any advice?

You rarely will do this.

Use landmarks. Find the medial limbus of the eye. Imagine a vertical line going straight down directly parallel and along the medial limbus of the eye. Now palpate the inferior orbital rim. The foramen is approximately 1 cm below the infraorbital rim along this imaginary line coincident with the medial limbus of the eye.

 

[PreDentTechySon]

Hey all, first year dental student here. Need advice on ASANB

We are learning anesthesia injection techniques right now, really cool stuff. One injection, the anterior superior alveolar nerve block (infraorbital) has me a bit worried! I've seen extractions done on 6-11 on one patient in a single visit, so I think bilateral ASA would be a viable injection for that procedure.

In our notes, it says to use a long needle, parallel to the maxilary bone, and proceed up to the infraorbital foramen until you contact the bone on the roof of the infraorbital foramen!!! Last semester we had gross anatomy, and lemme tell ya, finding that foramen without destroying overlying structures was a PAIN. I think it will be even harder with a syringe. The needle we use is a long needle about 32mm and we go in from the height of mucobuccal fold above Mx1P.. We only go in about 16mm. I'm worried about possibly damaging the eye if the patient freaks out, and not being able to find the foramen with the needle.

Any advice?

16mm for the ASA? Our school’s recommendation is 5mm...

If you’re wanting to get the infraorbital foramen that directly you could consider extra-oral administration (which I wouldn’t suggest for a variety of reasons).

 

[Vicviper]

No one ever really does the Infra-orbital, it's really not necessary. Just infiltrate and you'll be fine. I just extracted 5-12 this week with 3 infiltrations, and a few drops on the roof of the mouth. The only time I would even consider using the infra-orbital is if it was a super hot tooth, and for some reason waiting for antibiotics wasn't a choice.

 

[UpperBite]

I would agree that it isn't used much. With the success of maxillary infiltrations, it doesn't seem necessary. I have never used this block in practice. I only use a block on mandibular cases or if I am doing a full mouth (or close to full mouth) extractions where I don't want to run close to the max dose. And even then, I haven't gotten close to the max dose of anesthetic.